By far, the most common problem we see in dogs is Periodontal Disease (Perio).
Hands down, every day of the week, without any competition, Periodontal Disease is the most common disease in dogs. Depending on the study you refer to, we know that 80-85% of dogs over the age of 3 years have some degree of Periodontal disease.
WHAT IS PERIODONTAL DISEASE?
So, in Veterinary Dentistry our main focus of treatment and prevention is Periodontal disease. As our pets age, the degree of Periodontal disease increases, simply because the disease is chronically progressive – if you’ve been around long enough, the disease will be worse.
Periodontal disease at first glance appears to be a simple disease. Bacteria are in the mouth and they develop a coating on our teeth called plaque. This is a mix of bacteria, saliva and food materials. The immune system does not like the bacteria that reside in the plaque and as such, sets up a reaction towards it. This reaction is Periodontal disease, and it can have far reaching effects.
Initially the reaction occurring in Periodontal disease is Gingivitis, the inflammation of the gum tissue. What we see in the mouth is red, inflamed gums. This can be painful, and contribute to further disease in the body. The good news? Gingivitis is completely reversible! Physical removal of the plaque, especially from under the gumline will resolve gingivitis, with the tissues involved going back to normal.
However, if the gingivitis is not treated, the disease progresses deeper and develops into Periodontitis. The space between the gum and the tooth fills with plaque. As the body reacts to this plaque, the gum tissue starts to be destroyed leading to a deeper pocket. This deeper pocket continues to fill with plaque, and the body keeps fighting and reacting.
 |
| Hold on mum: there's something between your teeth! |
These tissues do not ever return. Periodontitis is irreversible! Ultimately the advancement of Periodontitis leads to teeth falling out… after a lot of pain and infection.
By far the biggest problem of advancing Periodontal disease is not that the teeth fall out. The biggest problem is that the bacteria from the plaque have access to your dog’s blood stream. In conjunction with the by-products of all the fighting going on, the bacteria cause problems in various other parts of the body: heart, kidneys, liver and other areas.
We don’t care that your dog’s breath stinks (I don’t snuggle up to him at night!). As vets, we worry about the pain. We worry about the effects on other parts of the body. We know that your pup is not about to keel over because his gums are red, but we know that if we don’t manage Periodontal disease, your dog’s long term outlook isn’t as long.
TREATMENT OF PERIODONTAL DISEASE
The ONLY way to treat Periodontal disease is to physically remove the plaque. From all its hiding spots.
Plaque is a biofilm, and as such the various bacteria that are present in it help each other out, and act as a community. These stubborn guys are much more resistant to chemical attack when in this biofilm. So, applications of medications either topically or systemically (eg: antibiotics) can have an effect, but ultimately cannot remove the plaque.
This must be done physically. The only way to effectively and substantially influence plaque levels is to have a professional scale and polish. This must be performed under a general anaesthetic.Initially the patient is thoroughly examined: every tooth is probed and the individual health of the tooth and its surrounding tissues is evaluated. This may also require further investigation with dental x-rays.
Probing the gingival space around each of the 42 teeth (hopefully!) in the dog’s mouth is time consuming and is vital to planning what treatments will be required by that individual.
Once the space around each tooth is measured and the dental and oral health assessed, treatment can begin.
If we are only dealing with mild to moderate Periodontal disease, all that may be required to treat the areas of gingivitis and prevent further disease, is a scale and polish. Advanced Periodontal disease where there is bone loss present, may require the extraction of affected teeth.
A scale and polish consists of physically disrupting and removing the plaque on the teeth and under the gums. This is done in several ways. Initially the bulk of the material is removed with sharp hand instruments. These dental instruments are designed to remove plaque and calculus off the various tooth surfaces, especially the subgingival space under the gumline.
The subgingival space is the most important part of the mouth when it comes to Periodontal disease. It is where the actual disease is occurring. Not on the tooth surface that we can see, but under gumline, away from view. This area must be both thoroughly cleaned, and protected from damage. Special curettes designed to be used in this area are used to clean under the gum.
Once the space around each tooth is measured and the dental and oral health assessed, treatment can begin.
If we are only dealing with mild to moderate Periodontal disease, all that may be required to treat the areas of gingivitis and prevent further disease, is a scale and polish. Advanced Periodontal disease where there is bone loss present, may require the extraction of affected teeth.
A scale and polish consists of physically disrupting and removing the plaque on the teeth and under the gums. This is done in several ways. Initially the bulk of the material is removed with sharp hand instruments. These dental instruments are designed to remove plaque and calculus off the various tooth surfaces, especially the subgingival space under the gumline.
The subgingival space is the most important part of the mouth when it comes to Periodontal disease. It is where the actual disease is occurring. Not on the tooth surface that we can see, but under gumline, away from view. This area must be both thoroughly cleaned, and protected from damage. Special curettes designed to be used in this area are used to clean under the gum.
An ultrasonic scaler is also used in the majority of scale and polishes. This machine uses high frequency sound to break up plaque and calculus. When used correctly, they are minimally invasive or damaging, however they can in some patients be painful when used on some teeth.
Finally, a polishing head in conjunction with polishing paste is used to remove those last little remnants of plaque on the tooth surfaces above and below the gumline of all the teeth.
ANAESTHESIA-FREE CLEANING: MY THOUGHTS...
My biggest concern with this approach revolves around the difficulty in being able to access the area under the gumline.
It is imperative to access this area safely for both examination (and therefore diagnosis) and treatment. With a conscious patient, the placement of a sharp probe under the gum is dangerous and painful.
As the material causing periodontal disease ONLY occurs under the gumline, and requires physical removal, the ability of operators to access under the gumlines safely with sharp instruments becomes an issue also, let alone the pain caused by scaling root surfaces.
At best anaesthesia-free dental cleaning removes the obvious calculus and plaque on the tooth surface above the gumline - giving the false impression of healthy “clean” teeth.
PREVENTION
Prevention is an ongoing process. Simply put there is NO prevention available that by itself stops the progression of Periodontal disease. Even together we can’t stop, but we can manage and slow Periodontal disease. The aim of any prevention is to reduce the amount of plaque and or tartar. So what do we use? How can we help our pups?
#1. Most Australians turn to bones
A bone for your dog to chew probably does help reduce plaque. The issues with bones though are many – broken teeth, choking, gut problems. Do they occur with every bone eaten? Nope. Could it happen to your dog? Yep. If you’re going to use bones, which I don’t recommend, always use raw and UN-CUT bones. Never cut. Not in any way.
#2. Chew products are an improvement for the most part to bones.
Products such as Greenies, Dentastix and OraVet chews, all have studies to back up their claims.
There are other products out there too. Most body parts of animals have at some stage been dried and used for dogs to chew on. Are these safe and effective? Not sure. No one studies these things, we just hear stories (good and bad!).
#3. Dental diets are great, any of them...
Your pet must eat something, so why not a nutritious diet that helps reduce plaque? They are useful and work in a couple of ways, but as mentioned to start with, will not be an effective product on its own. The other products on the market – water additives, food additives – have little evidence to back them up.
The idea behind chewing is that the physical action will remove plaque. Following this and being much more specific in its action is brushing.
#2. Chew products are an improvement for the most part to bones.
There are other products out there too. Most body parts of animals have at some stage been dried and used for dogs to chew on. Are these safe and effective? Not sure. No one studies these things, we just hear stories (good and bad!).
#3. Dental diets are great, any of them...
Your pet must eat something, so why not a nutritious diet that helps reduce plaque? They are useful and work in a couple of ways, but as mentioned to start with, will not be an effective product on its own. The other products on the market – water additives, food additives – have little evidence to back them up.
The idea behind chewing is that the physical action will remove plaque. Following this and being much more specific in its action is brushing.
4. Brushing daily is still, by far, the very best we can do for prevention.
Why do you think dentists don’t tell us to chew bones, or drink a certain drink? Because brushing DOES work.
As a Veterinary Dentist, I long for the day where we can have a product that stops all this pain and disease that we see. It doesn’t look like that day is near. We must work together to keep our dogs' mouths healthy. It is an ongoing job.
Dr Aaron Forsayeth from Advanced Animal Dentistry graduated from the University of Queensland with a BVSc (Hons) in 1996. He was awarded Membership of the Australian College of Veterinary Scientists (MACVSc) in Veterinary Dentistry by examination in 2004. Aaron worked solely in mixed practice for over 9 years, spending much of this time at a large Animal Hospital on the Gold Coast. Aaron has been working in full-time dental referral practice since 2006.
Written for Australian Dog Lover - April 2017
Why do you think dentists don’t tell us to chew bones, or drink a certain drink? Because brushing DOES work.
As a Veterinary Dentist, I long for the day where we can have a product that stops all this pain and disease that we see. It doesn’t look like that day is near. We must work together to keep our dogs' mouths healthy. It is an ongoing job.
Written for Australian Dog Lover - April 2017